COVID-19 Vaccine and Cutaneous Adverse Reactions

Yes, COVID-19 vaccines can cause both rash and hair loss, though these reactions are uncommon and typically self-limited.

Rash Following COVID-19 Vaccination

Cutaneous manifestations occur in approximately 3.8% of vaccinated individuals, with mRNA-based vaccines showing higher rates at 6.9% 1
Injection site reactions are by far the most common cutaneous manifestation, accounting for 72.16% of all skin reactions 1
Systemic symptoms including rash affect 5-40% of vaccine recipients and typically persist for 1-2 days 2

Most cutaneous reactions are mild and self-limiting, resolving within 2-3 days 3
Severe reactions such as anaphylaxis are extremely rare, occurring in only 0.05% of cases 1
Flares of pre-existing dermatoses can occur but represent only 0.07% of cutaneous reactions 1

For typical rash reactions occurring within 0-3 days: supportive care with anti-inflammatory agents is sufficient 2
If rash persists beyond 3 days or begins 5+ days post-vaccination, urgent evaluation is required to rule out immune-mediated complications 2
Patients with pre-existing skin conditions should receive additional precounseling and monitoring 1

Alopecia areata (AA) following COVID-19 vaccination is rare but documented, with cases reported after both mRNA vaccines (BNT162b2/Pfizer) and viral vector vaccines (ChAdOx1/AstraZeneca) 4, 5, 6
In a systematic review of 51 patients, 52.9% developed new-onset AA while 47.1% experienced recurrence or exacerbation of pre-existing disease 6
The Pfizer vaccine was most frequently associated with AA (45.1%), followed by ChAdOx1 (27.5%) and Moderna (19.6%) 6

AA most commonly occurs within one month after the first dose, with incidence decreasing gradually over time 6
In reported cases, rapid hair loss occurred 2-3 weeks after vaccination 4
Hair loss can present as widespread involvement or single patches with typical trichoscopic features of AA 4

Both mRNA and viral vector vaccines induce Th1 cell activation with pro-inflammatory cytokine release, which may enhance autoimmune mechanisms in predisposed individuals 4
In patients with pre-existing inflammatory dysregulated pathways, vaccine-induced immune activation may trigger hair loss 4

Topical or systemic corticosteroids are first-line treatment, used in the majority of reported cases 6
JAK inhibitors (tofacitinib) represent an alternative treatment option, though 3 of 11 patients experienced exacerbations after treatment 6
Psychological support is crucial, as reassurance about the non-serious nature of this complication is the most important factor in earlier resolution 7

The benefits of COVID-19 vaccination outweigh the risk of cutaneous adverse reactions, including hair loss 4
Immune-mediated side effects remain rare events and should not prevent vaccination in eligible patients 4

Rash accompanied by severe headache, shortness of breath, chest pain, leg swelling, or persistent abdominal pain requires immediate evaluation for serious complications like vaccine-induced immune thrombocytopenia and thrombosis (VITT) 3, 2
Symptoms persisting beyond 3 days or beginning 5+ days post-vaccination warrant urgent assessment 2

Patients with history of alopecia areata should be informed about potential recurrence risk but should still receive vaccination 4, 6
Individuals with pre-existing skin conditions require additional precounseling about potential flares 1
Most cutaneous reactions are not contraindications to subsequent vaccination except for anaphylaxis 1